BRITISH MEDICAL JOURNAL
8 MARCH 1975
person other than a widow, widower, or single person can daim a housekeeper
alloance in spite of representations from
professional women's organizations, this being politicaly unacceptable. Also a wife's earned income alowance is unrelated to her family responsibilities. I suggest tat a nmrried woman who has dhildren under 16 or a dependent relative and who is in at least half-time employment shoic be given an earned income allowance ifbt increases with the number dependents. This would enable her to pay for adequate domestic help, thus increasing her work capacity without seeing her own wages disappear in essential expenses.-I am, etc., MARGARET ELMES Belfast
SIR,-Your leading article "State of Health'
573
Mpha-fetoprotein-in Amoebic Colitis and Liver Abscess' Smi,I would lke to report the association of amoebic colits and amoebic liver abscesses with the finding of a-fetoprotein (AFP) in the serum, as evidenced by the following case. To the best of my knowledge this assciation has not been previously described. A 59-year-old Negro mn presented with a twoweek history of bloody diarrhoea, painful abdominal swelg, and- anorexia. He was dehydrated, cachectic, anaemic, and deeply-jaundiced. There was right basal atelectasis and a ..tender, soft, fluctuant mass of 10 cm-diameter arising from the liver. The testes were normal. Serum protein was 61 g/l, total bilirubin 213;75 ILmol/l (12-5 mg/l00 ml), of which 104-3 #molIA (6.1 mg/100 ml) was conjugated. All hepatic enze levels were grossly elevated, the prothrom, ini dex was 60%, and the E.S.R. was 120 mm in thefirst hour (Westergren). Entamoeba histolytica was recovered from the stool and from malodourous blood-stained aspirate from the liver. Tests for serum AFP, utilizing the Ouchterlony immunodiuon method, were positive. In spite of energetic therapy the patient died and necropsy confirmed an enormous hepatic abscess. There was no evidence of cirrhosis, and careful search failed to reveal any tumour. The
(28 Decenber, p. 732) quotes figures which show that only a minority of Briitish-trined women doctors are fully employed in senior posts witiin the NjH.S. It does not quantify part-time work by women, nor ithe loss to intestine showed numerous abscesses. The testes the community of ,trained doctors by emigration. Dr. Dora Black (15 February, p. 393) seeks a solution to the problems of "women" doctors so that "a large work force, eager to use their skilOs" can retur to adequately paid employment, bearing in nind the financial consequences of -suh work which includes, in Dr. Black's submission, he substantial sum of £1330 per annum devoted entirely to -her home and family. When this distressing problem is oDnsid4red it must ibe aepted that. any success in the medical profession depends on tie right skills being supplied Where and when these ace required. Such denmnds are cot ood. Mediceasily compatible with m
4y quaified mother, prsmably cager 'te have children, may then. have to make from either thir own profssional as ons and. purses or- their busands'. lw6u1~dwy be helped if. .-we. were all paid ntoe? Tis could prevent so of thm droppingout, but -there might be, incmveraent competition om potetial emiigre Is it posibl tD produce sick patieits in the eight plae and at, she right time, or do the rest of us cope i ncrsny. with th emergency wok i-n unpopular places? Should we seriously consider exra pay for some doctos to provide for tiheir Uhhden's care, filet eteaks, and dhee uniginable exclusively medical clothes in the face of existing tax differentls? What-ae the inequaliies in returs fram prfessiokial joumals and conferences? It is time Dr. Black and hir feLiowsufferers e e their position -honestly and befoce ny women stents give up in despair. As a whole-time cnsltnt psyohiatrist (and a wowmna) I woudd -assure such students -hat I at- least have been treated absoutely fairly by my nmle colleagues. It is only when proessional women seek to gratify their maternal instincts ftt 'they must choose between baving their cake and eatng it; die choice is theirs. It would. be a pleasant dhange to ha some constructive sgesions from dse mediai nxshers is worh wbile instead of who feel that a constat stream of excuses and demadsfor preferentil treatmenti-4 am, etc., NANcy K. SHRUBSHEL Exe Vale Hospital, Wonford, Exeter
were normal.
T pert, M. B., -Uriel, J., and de Nechaud, B., New Engld 7ournal of Medicine, 1968, 278, 984. 8 Gefroy, Y., et al., PTesse Mddicale, 1970, 78, 1107.. 9 Purves, L. R., and Geddes, B. W., Lancet, 1972, 1, 47.
Levodopa and Dopadecarboylase in Traat t of Postual Hypotension SN4-We wish to report the ase of a man aged 65 who for many _vean- had suffered from severe postul hypotension, which latterly had been associated with an etrapyramidal. s . This had been treated with levodoa. At that time a study -by riheoeaicophalgkaphiy of the patient's showed an postural regulatory meihani obvious deeease in cerebal blood flow when the bloods preire fel1, despite an aceompanying tachycardia and vasooonstriction -of the leg vessels. These symp were unlike those seen in the Shy-Drager syndrome.' The hypotension was ffectd by treatment with dihydroergotamine, phenyephrine, and 'heptaminol together withlevodopa. In 1974 -Modopar -(levodopa with benserazide) was substituted for levodopa. After three weeks furte study by rheoencephalography siowed an-increase in cerebral blood -ow when-the paient was sitting, which, nevertheless, was associa.ted with as large a. fall in blood pressure as in the previous study (from 125/90 msmHg to 60/40 nuHg). Despite this fall the patient did not feel faint These finding- invite thee coaw (1) Blood pressure measuremnts in posturl lypotension are not a good guide to the state a( cerebral blood flow.2 (2) The findings orroborate in man the part played by central cateo amin inthe ipotural regulation of cerebral blood flow sreadiy shown in animals.3 (3) The is a emically and anatomicelly distinct ction- on the nervous mechanistus responsible foe the postural regulation of blood flow and the arterial blood pressure.4-We are, etc.., F. BoISMAR J. BOQUT
AFP bas been demonstrated as a measuable parameter of aligqncy, more particularly of primary--bepatocellular carcinoma and esryonic tumours of the ovary and testis. However, this- protein has been demonstated in the serum of patients with &wstrdc,1- pancreatic,5 and oesophageal carcinoma,6 in eaci case with iiepatic metastses. False positive results unassociated with maligancy are rawe but have been reportedin Vira hpatitis and cirrhosis,7 thgh in the later the possibility of subdimical primary liver lcerc could not be excludid. In 16 clinical cases of amoebic abscess, ..five f p logically, tests. for IAP were negative.7 Though a posiive AF, test. is good corohrative evidenp of bepatic or goad malignancy, sa tpos:iiIity of ofter coodtions should be b&ii-ia imnd. With the o adiioimmunoassy increased senv of fun,Qss techniques it is quite over in possible that otber _1etic diseases will be found to be assiit:d with the presence of the dse ithe serum. Pperi- Rouen, Pr.ce mental evidncse WIopwrt. this is' anaWle from Purves,' who Ms shown that the ad- r Shy, G. M., asd Drager, . A., Archives of Neurology, 1960,2, 5I1. ministation of duith1wlnitrosamine t to 2 Skin0jje, 0. Y., and Srndad, S., in Brainand Blood Plow: 4th ntr,ian symposium baboons enuses a ri inw AEPPlevel duixng the -n regultion of cerebral blood flow, ed. the. early bepatotoxic; stige, during liver reR. W. R. Rsell. ndn, Pitman, 1971. S 0. A;, Annual eics of PhYsiology, 1974, Smth, generation following a rest, period, and once 34, 93. a tumour is establi Md. 4 Wilson, M. F., et dCirculation al., Research, 1961,9i, 49i. -It is olded iat .a. tbepatic Mass with APP tet x POxsitive not. eslude treatable disease without irter invesig on, and a study of the. i ce af AF? posiMen, Women, and Obesty tivity in beipi spaeq pying lesions of ize, rethe liver would b of itestI a ec. SmI,-The selessesuetsof bo fered to in your leading arde (2 NovemPAUL GSTAZ ber, V. 249), is an area of ira n intres The paper. by Ashwel and BtEbeHi whIch Depanment of Medicine, Umveraity of Cape TOwn Medieni Shool anid you discussed pses -tait iicafe Groote Schuur Hospita,* ebat 90% of overweight women and 70% Cape Town Of overweight men considered enselves to 1 Alpert, E., Pinn, V. W.,-and Iselbacher, K. J., be overweiht. New England Yournd of Medicine, 1971, 285, Fune- insmgt on the subjeat of body 1058. 2 Kozower, M., et al., New Englnd Yournal of se perception is obtained from our -study Medicine, 1971, 2,S 1059. a healt 3 Mehkn, D. J., BuRley. 1. H., ad Viernik, in- two- S6ih towns. D P. H., New Englad' 7ourim of Medicine, 1971, srey of in ithe-pAiwy o kirn in 285, 1060. 4 Bierfeld, J. L., et l., Amnaican Younal of one scbuol in each town gme -drI S Digestive Diseases, 1973,_ It, 514. Mo!hMs-were asked ain a self-admiistered 5 O'CAnor, G. T., at ai, C.oncr, l70, 2s, 1091. 6 Spragin, J., Haf1,- W. IL, -p White, H.. J., qestionnire to- give thir height and Annals of Intrnl- Medicie, 1972,- 77, 322.' w*ht- A- andom-ample :of 40 modthe
8 MARCH 1975
person other than a widow, widower, or single person can daim a housekeeper
alloance in spite of representations from
professional women's organizations, this being politicaly unacceptable. Also a wife's earned income alowance is unrelated to her family responsibilities. I suggest tat a nmrried woman who has dhildren under 16 or a dependent relative and who is in at least half-time employment shoic be given an earned income allowance ifbt increases with the number dependents. This would enable her to pay for adequate domestic help, thus increasing her work capacity without seeing her own wages disappear in essential expenses.-I am, etc., MARGARET ELMES Belfast
SIR,-Your leading article "State of Health'
573
Mpha-fetoprotein-in Amoebic Colitis and Liver Abscess' Smi,I would lke to report the association of amoebic colits and amoebic liver abscesses with the finding of a-fetoprotein (AFP) in the serum, as evidenced by the following case. To the best of my knowledge this assciation has not been previously described. A 59-year-old Negro mn presented with a twoweek history of bloody diarrhoea, painful abdominal swelg, and- anorexia. He was dehydrated, cachectic, anaemic, and deeply-jaundiced. There was right basal atelectasis and a ..tender, soft, fluctuant mass of 10 cm-diameter arising from the liver. The testes were normal. Serum protein was 61 g/l, total bilirubin 213;75 ILmol/l (12-5 mg/l00 ml), of which 104-3 #molIA (6.1 mg/100 ml) was conjugated. All hepatic enze levels were grossly elevated, the prothrom, ini dex was 60%, and the E.S.R. was 120 mm in thefirst hour (Westergren). Entamoeba histolytica was recovered from the stool and from malodourous blood-stained aspirate from the liver. Tests for serum AFP, utilizing the Ouchterlony immunodiuon method, were positive. In spite of energetic therapy the patient died and necropsy confirmed an enormous hepatic abscess. There was no evidence of cirrhosis, and careful search failed to reveal any tumour. The
(28 Decenber, p. 732) quotes figures which show that only a minority of Briitish-trined women doctors are fully employed in senior posts witiin the NjH.S. It does not quantify part-time work by women, nor ithe loss to intestine showed numerous abscesses. The testes the community of ,trained doctors by emigration. Dr. Dora Black (15 February, p. 393) seeks a solution to the problems of "women" doctors so that "a large work force, eager to use their skilOs" can retur to adequately paid employment, bearing in nind the financial consequences of -suh work which includes, in Dr. Black's submission, he substantial sum of £1330 per annum devoted entirely to -her home and family. When this distressing problem is oDnsid4red it must ibe aepted that. any success in the medical profession depends on tie right skills being supplied Where and when these ace required. Such denmnds are cot ood. Mediceasily compatible with m
4y quaified mother, prsmably cager 'te have children, may then. have to make from either thir own profssional as ons and. purses or- their busands'. lw6u1~dwy be helped if. .-we. were all paid ntoe? Tis could prevent so of thm droppingout, but -there might be, incmveraent competition om potetial emiigre Is it posibl tD produce sick patieits in the eight plae and at, she right time, or do the rest of us cope i ncrsny. with th emergency wok i-n unpopular places? Should we seriously consider exra pay for some doctos to provide for tiheir Uhhden's care, filet eteaks, and dhee uniginable exclusively medical clothes in the face of existing tax differentls? What-ae the inequaliies in returs fram prfessiokial joumals and conferences? It is time Dr. Black and hir feLiowsufferers e e their position -honestly and befoce ny women stents give up in despair. As a whole-time cnsltnt psyohiatrist (and a wowmna) I woudd -assure such students -hat I at- least have been treated absoutely fairly by my nmle colleagues. It is only when proessional women seek to gratify their maternal instincts ftt 'they must choose between baving their cake and eatng it; die choice is theirs. It would. be a pleasant dhange to ha some constructive sgesions from dse mediai nxshers is worh wbile instead of who feel that a constat stream of excuses and demadsfor preferentil treatmenti-4 am, etc., NANcy K. SHRUBSHEL Exe Vale Hospital, Wonford, Exeter
were normal.
T pert, M. B., -Uriel, J., and de Nechaud, B., New Engld 7ournal of Medicine, 1968, 278, 984. 8 Gefroy, Y., et al., PTesse Mddicale, 1970, 78, 1107.. 9 Purves, L. R., and Geddes, B. W., Lancet, 1972, 1, 47.
Levodopa and Dopadecarboylase in Traat t of Postual Hypotension SN4-We wish to report the ase of a man aged 65 who for many _vean- had suffered from severe postul hypotension, which latterly had been associated with an etrapyramidal. s . This had been treated with levodoa. At that time a study -by riheoeaicophalgkaphiy of the patient's showed an postural regulatory meihani obvious deeease in cerebal blood flow when the bloods preire fel1, despite an aceompanying tachycardia and vasooonstriction -of the leg vessels. These symp were unlike those seen in the Shy-Drager syndrome.' The hypotension was ffectd by treatment with dihydroergotamine, phenyephrine, and 'heptaminol together withlevodopa. In 1974 -Modopar -(levodopa with benserazide) was substituted for levodopa. After three weeks furte study by rheoencephalography siowed an-increase in cerebral blood -ow when-the paient was sitting, which, nevertheless, was associa.ted with as large a. fall in blood pressure as in the previous study (from 125/90 msmHg to 60/40 nuHg). Despite this fall the patient did not feel faint These finding- invite thee coaw (1) Blood pressure measuremnts in posturl lypotension are not a good guide to the state a( cerebral blood flow.2 (2) The findings orroborate in man the part played by central cateo amin inthe ipotural regulation of cerebral blood flow sreadiy shown in animals.3 (3) The is a emically and anatomicelly distinct ction- on the nervous mechanistus responsible foe the postural regulation of blood flow and the arterial blood pressure.4-We are, etc.., F. BoISMAR J. BOQUT
AFP bas been demonstrated as a measuable parameter of aligqncy, more particularly of primary--bepatocellular carcinoma and esryonic tumours of the ovary and testis. However, this- protein has been demonstated in the serum of patients with &wstrdc,1- pancreatic,5 and oesophageal carcinoma,6 in eaci case with iiepatic metastses. False positive results unassociated with maligancy are rawe but have been reportedin Vira hpatitis and cirrhosis,7 thgh in the later the possibility of subdimical primary liver lcerc could not be excludid. In 16 clinical cases of amoebic abscess, ..five f p logically, tests. for IAP were negative.7 Though a posiive AF, test. is good corohrative evidenp of bepatic or goad malignancy, sa tpos:iiIity of ofter coodtions should be b&ii-ia imnd. With the o adiioimmunoassy increased senv of fun,Qss techniques it is quite over in possible that otber _1etic diseases will be found to be assiit:d with the presence of the dse ithe serum. Pperi- Rouen, Pr.ce mental evidncse WIopwrt. this is' anaWle from Purves,' who Ms shown that the ad- r Shy, G. M., asd Drager, . A., Archives of Neurology, 1960,2, 5I1. ministation of duith1wlnitrosamine t to 2 Skin0jje, 0. Y., and Srndad, S., in Brainand Blood Plow: 4th ntr,ian symposium baboons enuses a ri inw AEPPlevel duixng the -n regultion of cerebral blood flow, ed. the. early bepatotoxic; stige, during liver reR. W. R. Rsell. ndn, Pitman, 1971. S 0. A;, Annual eics of PhYsiology, 1974, Smth, generation following a rest, period, and once 34, 93. a tumour is establi Md. 4 Wilson, M. F., et dCirculation al., Research, 1961,9i, 49i. -It is olded iat .a. tbepatic Mass with APP tet x POxsitive not. eslude treatable disease without irter invesig on, and a study of the. i ce af AF? posiMen, Women, and Obesty tivity in beipi spaeq pying lesions of ize, rethe liver would b of itestI a ec. SmI,-The selessesuetsof bo fered to in your leading arde (2 NovemPAUL GSTAZ ber, V. 249), is an area of ira n intres The paper. by Ashwel and BtEbeHi whIch Depanment of Medicine, Umveraity of Cape TOwn Medieni Shool anid you discussed pses -tait iicafe Groote Schuur Hospita,* ebat 90% of overweight women and 70% Cape Town Of overweight men considered enselves to 1 Alpert, E., Pinn, V. W.,-and Iselbacher, K. J., be overweiht. New England Yournd of Medicine, 1971, 285, Fune- insmgt on the subjeat of body 1058. 2 Kozower, M., et al., New Englnd Yournal of se perception is obtained from our -study Medicine, 1971, 2,S 1059. a healt 3 Mehkn, D. J., BuRley. 1. H., ad Viernik, in- two- S6ih towns. D P. H., New Englad' 7ourim of Medicine, 1971, srey of in ithe-pAiwy o kirn in 285, 1060. 4 Bierfeld, J. L., et l., Amnaican Younal of one scbuol in each town gme -drI S Digestive Diseases, 1973,_ It, 514. Mo!hMs-were asked ain a self-admiistered 5 O'CAnor, G. T., at ai, C.oncr, l70, 2s, 1091. 6 Spragin, J., Haf1,- W. IL, -p White, H.. J., qestionnire to- give thir height and Annals of Intrnl- Medicie, 1972,- 77, 322.' w*ht- A- andom-ample :of 40 modthe
